Recurrent thoracic outlet syndrome: causes and treatment

Area of Science:

• Orthopedics
• Neurosurgery
• Vascular Surgery

Background:

• Thoracic outlet syndrome (TOS) can recur after initial surgical intervention.
• Recurrence necessitates reoperation to address persistent or new symptoms.

Purpose of the Study:

• To analyze clinical history and operative findings in patients undergoing reoperation for recurrent TOS.
• To classify recurrent TOS based on brachial plexus fixation and guide treatment.

Main Methods:

• Review of clinical data and surgical findings in 29 patients with recurrent TOS.
• Classification of recurrent TOS by brachial plexus fixation site (lower vs. upper tract).

Main Results:

• Recurrence causes include operation-related factors (retained rib, periosteal regrowth), postoperation issues (infection, early mobilization), or trauma.
• Lower tract recurrent TOS involves plexus fixation at the first rib level.
• Upper tract recurrent TOS involves plexus fixation in the neck by the anterior scalene muscle.

Conclusions:

• Surgical management of recurrent lower tract TOS includes neurolysis, removal of residual first rib/periosteum, and fat-pad grafting.
• Surgical management of recurrent upper tract TOS involves scalenectomy, neurolysis, and plexus coverage with fat.